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Traditional APR (Lloyd-Davies Position, TAPR) is associated with high rates of tumour perforation, positive CRM, perineal wound breakdown and local recurrence. Prone APR (PAPR) may result in improved outcomes. We report our technique and early results.Retrospective analysis was performed on 24 patients who underwent PAPR (prone perineal dissection, levator muscles resected en-bloc with rectum and anus) and compared with a control group of 11 patients undergoing TAPR for low rectal cancer, (14 M, 10 F vs 7M, 4 F, mean age 66 vs 70, mean ASA 1.8 vs 2.5, mean distance of tumour from dentate 31.1 mm vs 28.1 mm, mean follow-up 15.5 vs 30.2 months, respectively), in a single specialist colorectal unit.PAPR was safe with acceptable oncological outcomes. Perineal wounds were aproblem with future consideration of a plastic closureprocedure. Local recurrence was low, but the duration of follow-up was short.